Specialists in Child and Adolescent Psychiatry

256 Pages·2013·1.2 MB·English

A Competency Based Curriculum
for Specialist Training in Psychiatry

Specialists in
Child and
Adolescent
Psychiatry

Royal College of Psychiatrists
Approved 14 May 2013

© Royal College of Psychiatrists 2013

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Child and Adolescent Psychiatry Curriculum 2013 Table of Contents

© Royal College of Psychiatrists 2013 ......................................................................................................................... 1
Child and Adolescent Psychiatry Curriculum 2013 Table of Contents ....................................................................................... 2
Introduction ...........................................................................................................................................................................1 0
1. Development of the Curriculum ........................................................................................................................ 10
2. Purpose of ST4-6 Curriculum for Child & Adolescent Psychiatry ......................................................... 11
3. Core trainees (CT1-3) ...........................................................................................................................................1 2
4. Higher Trainees (ST4-6) .......................................................................................................................................1 3
Mandatory ILO (H)s for Higher Training ............................................................................................................ 14
Selective ILO (H) s .....................................................................................................................................................1 4
1. Induction ................................................................................................................................................................. 15
2. Placements .............................................................................................................................................................1 5
3. Academic Learning Experiences for Higher Training (ST4-6) ........................................................... 16
4. Research for Higher Trainees ......................................................................................................................... 16
5. Supervision ............................................................................................................................................................1 7
6. Caseload and Experience ................................................................................................................................. 18
7. Concerns from Trainees ....................................................................................................................................1 9
8. Mapping the Curriculum into the Scheme ................................................................................................. 19
9. Involvement of carers and patients in workplace-based assessments ......................................... 21
Higher Intended Learning Objectives – ILO (H) ..................................................................................................... 22
ILO (H) 1: Professionalism for Child and Adolescent Psychiatrist (Mandatory) .................................... 22
2
ILO (H) 2: Establishing and maintaining therapeutic relationships with children, adolescents and
families (Mandatory) ......................................................................................................................................................3 2
2.1 Builds trust and respect ....................................................................................................................................3 2
2.2 Advise on young people’s confidentiality, competence (capacity) to make treatment
decisions, and consent and refuse treatment.................................................................................................. 34
ILO (H) 3: Safeguarding Children (Mandatory) ................................................................................................. 36
3.1 Detects alterations in children’s development that might suggest the child has been
maltreated or neglected ...........................................................................................................................................3 6
3.2 Works with the family and professional network to clarify and manage safeguarding .......... 38
ILO (H) 4: Undertake clinical assessment of children and young people with mental health
problems across the age range (Mandatory) ....................................................................................................... 41
4.1 History taking and interviewing using developmental approach:- ................................................. 42
4.2 Physical examination of children across the age range ....................................................................... 43
4.3 Use of appropriate rating scales / questionnaires / instruments ..................................................... 44
4.4 Seeking information from available outside sources ............................................................................ 45
4.5 Diagnosis formulation and feedback of assessment and management plan to parents and
child or young person ................................................................................................................................................4 6
4.6 Note-keeping and clinical correspondence................................................................................................ 48
ILO (H) 5: Main Clinical Conditions (including Axis I diagnoses) in Childhood and Adolescence
(Mandatory) .......................................................................................................................................................................5 0
5.1 Assesses and manages the main clinical conditions in the under 5s .......................................... 50
5.2 Assesses and manages the main clinical diagnoses in preadolescent, school aged child or
continuing from under 5s .........................................................................................................................................5 0
3
5.3 Assesses and manages the main clinical diagnoses in adolescence (commencing in
adolescence or continuing from childhood) – includes transition to Adult Mental Health
Services ...........................................................................................................................................................................5 0
Examples ........................................................................................................................................................................5 9
E.g. ILO (H) 5 Example: Sleep problems in a child under 5 ................................................................. 59
Example 2 – a child of primary school age ................................................................................................... 61
E.g. 5.2 Assesses and manages Hyperkinetic Disorder in the primary school aged child ........ 61
Example 3 – an adolescent ................................................................................................................................. 63
E.g. 5.3 Assesses and manages eating disorders in adolescence ....................................................... 63
ILO (H) 6: Managing Emergencies (Mandatory) ................................................................................................ 65
6.1 Assessment and management of psychiatric emergencies ................................................................ 65
ILO (H) 7: Paediatric Psychopharmacology (Mandatory) ............................................................................... 71
7.1 To recognise the indications for drug treatment in children and young people ........................ 71
7.2 Able to explain the risks and benefits and develop treatment decisions collaboratively ....... 72
7.3 Able to prescribe safely ....................................................................................................................................7 4
ILO (H) 8: Psychological Therapies in Child and Adolescent Psychiatry (Mandatory) ........................ 75
Aspect ..............................................................................................................................................................................7 5
8.1 Ability to assess suitability of children, adolescents and families for psychological therapy
............................................................................................................................................................................................7 5
8.2 Ability to refer appropriately and monitor progress of child and adolescent patients in
therapy ............................................................................................................................................................................7 8
8.3 Ability to deliver therapy to child and adolescent patients and families ...................................... 79
ILO (H) 9: Inpatient and day-patient Child and Adolescent Psychiatry (Mandatory) ......................... 81
4
9.1 Manages children/young people with severe/complex mental health problems in inpatient
or day-patient setting ................................................................................................................................................8 1
9.2 Provides day to day medical leadership for an inpatient or day-patient multi-disciplinary
team .................................................................................................................................................................................8 3
9.3 Understands the legal frameworks in use in an inpatient or day-patient setting ..................... 85
9.4 Manages the physical well-being of children/ young people in an inpatient or day patient
setting ..............................................................................................................................................................................8 7
ILO (H) 10: Management ILO for all ST4-6 CAP trainees (Mandatory) .................................................... 89
10.1 Managing risk .....................................................................................................................................................8 9
10.2 Evidence based Practice ................................................................................................................................. 91
10.3 Applying good practice standards .............................................................................................................. 93
10.4 Involving service users ...................................................................................................................................9 4
10.5 Audit .......................................................................................................................................................................9 5
ILO (H) 11: Teaching, Supervision & lifelong learning skills (Mandatory) ............................................. 97
11.1 Is able to organise and deliver teaching sessions in a variety of formats ................................ 97
11.2 Can complete a structured assessment of another’s performance and deliver constructive
feedback ..........................................................................................................................................................................9 8
11.3 Can supervise another’s clinical work ...................................................................................................... 99
ILO (H) 12: Research and scholarship ................................................................................................................. 100
12.1 Able to find and analyse research carried out by others ................................................................ 100
12.2 Can generate original research ................................................................................................................. 102
12.3 To disseminate findings................................................................................................................................1 04
ILO (H) 13: Assessment and Treatment in Child and Adolescent Neuropsychiatry (Selective) ... 105
5
13.1 To be able to assess and treat the psychiatric and behavioural consequences,
associations, and learning complications of acquired brain injury and progressive neurological
disorder .........................................................................................................................................................................1 05
13.2 To be able to diagnose and treat neuropsychiatric disorders such as ADHD, Tic Disorders,
Tourette Syndrome, and OCD ..............................................................................................................................1 06
13.3 To be able to carry out an assessment of an individual with autism spectrum disorder .. 108
13.4 To be able to contribute to the management plan of an individual with autism spectrum
disorder including use of psychotherapeutic and psychopharmacological interventions ............. 109
13.5 To be able to contribute to the management of neuroepileptic conditions ............................ 110
ILO (H) 14: Psychiatric management of children and adolescents with learning disabilities
(Selective) ........................................................................................................................................................................1 11
14.1 To be able to undertake a developmental assessment of child to make a diagnosis of
learning disability and assess associated comorbid conditions .............................................................. 111
14.2 To be able to take part in a multidisciplinary assessment of a child with learning disability
and associated mental health disorder and to formulate, implement and coordinate a
multidisciplinary assessment and treatment plan ....................................................................................... 112
14.3 To be able to liaise with colleagues and other child health professionals in associated
agencies to provide advice about assessment, diagnosis and management of children with
learning disability and associated mental health problems ..................................................................... 114
14.4 To be able to advise the courts/legal process in relation to children with learning
disability ........................................................................................................................................................................1 15
ILO (H) 15: Intended Learning Objective: Paediatric Liaison (Selective) .............................................. 117
15.1 To be able to advise on the presentation of psychiatric disorder in the context of physical
illness .............................................................................................................................................................................1 17
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15.2 To be able to assess and manage cases of self-harm, delirium and other psychiatric
emergencies that present in the A&E department or on the ward ....................................................... 119
(see also ILO (H) 6 – Managing Emergencies) ............................................................................................. 119
15.3 To be able to assess and manage somatising disorders including impairing functional or
unexplained medical symptoms .......................................................................................................................... 121
15.4 To be able to provide a liaison/consultation service to the paediatric team .......................... 122
ILO (H) 16: Medico-Legal Aspect of Child & Adolescent Psychiatry (Selective) .................................. 123
16.1 Prepare reports for the family courts ..................................................................................................... 123
16.2 Preparing reports for the criminal courts in child and adolescent mental health cases .... 124
16.3 Attend court and present evidence ......................................................................................................... 125
ILO (H) 17: Substance misuse (Selective) ......................................................................................................... 126
17.1 Carries out screening for drug/alcohol misuse in young people presenting with other
difficulties .....................................................................................................................................................................1 26
17.2 Deploys a range of techniques explicitly directed at securing engagement in young
people with substance use disorders. ............................................................................................................... 128
17.3 Carries out detailed, developmentally-sensitive assessments of drug/alcohol use in
young people to determine the presence or absence of substance misuse, and to assess its
impact, and contributory factors ......................................................................................................................... 130
17.4 Takes part in multidisciplinary/multi-agency assessments of children/adolescents with
comorbidity (co-occurring substance misuse and a psychiatric disorder) in order to formulate,
implement and coordinate a multi-agency intervention plan ................................................................. 132
17.5 Delivers integrated interventions for young people and their families with substance
abuse or dependence to meet the young person’s multiple needs ...................................................... 134
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17.6 Contributes to the development of specialist psychiatric substance misuse services for
children/adolescents ................................................................................................................................................1 36
ILO (H) 18: Transition to Adult Mental Health Care (Selective) ................................................................ 138
18.1 To assist young people with enduring mental health problems engage with adult mental
health services............................................................................................................................................................1 38
ILO (H) 19: Public Mental Health (Selective) .................................................................................................... 140
19.1 Knowledge of the findings of epidemiological research studies .................................................. 140
19.2 Understanding of the interaction between wider social determinants and mental well-
being ...............................................................................................................................................................................1 41
19.3 An awareness of the use of population screening ............................................................................. 142
19.4 Promotes mental well-being and prevention of mental illness, including liaison with media
..........................................................................................................................................................................................1 43
19.5 Understanding of the impact of stigma and other barriers to accessing mental health
services..........................................................................................................................................................................1 44
19.6 Understanding of the link between good emotional health and quality of life ...................... 145
19.7 Understands early intervention and economic evaluations ........................................................... 145
ILO (H) 20: Advanced Management and Leadership (Selective) .............................................................. 147
20.1 Business and Finance ....................................................................................................................................1 47
20.3 Analysing and Monitoring Outcomes ...................................................................................................... 150
20.4 Clinical Leadership within an organisation ........................................................................................... 151
Appendix I The ILOs abbreviated ...........................................................................................................................................1 54
Appendix II – Mapping the curriculum onto the GMC Good Medical Practice ..................................................................... 156
Appendix III - Assessment of Learning Outcomes for Child & Adolescent Psychiatry......................................................... 158
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Appendix IV Sample vignettes to show that WPBA can be used to explore many areas of curriculum depending on need and
stage of trainee .........................................................................................................................................................................1 72
Appendix V The Assessment system for core psychiatry training .......................................................................................... 179
Appendix VI - Guide for ARCP panels in Child and Adolescent Psychiatry (CAP) ST4-6 training ..................................... 184
Appendix VII Curriculum Learning Outcome Progress & Completion Tool ......................................................................... 212
Appendix VIII Trainees’ Guide to the Curriculum ................................................................................................................. 253

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Introduction

1. Development of the Curriculum

In preparing this curriculum we are indebted to the CAPSAC Advisory Papers (1999) and the curriculum developed from
those papers. We have written for a generation of trainees and trainers who have grown up with a 'high definition'
curriculum. It is a curriculum based on intended learning objectives with a clear indication of the threshold of being ready for
consultant practice; it strives towards excellence.

We have learned from the first curriculum drawn up in 2007/8. We surveyed the implementation of that curriculum with
trainees, trainers and TPDs in 2010 and repeated that survey in 2012 with some additional questions. We have discussed the
implementation of the curriculum with the training programme directors and representative trainees at biennial conferences
in 2010 and in 2012 in the light of the results of the two surveys. The Child and Adolescent Faculty Education and Curriculum
Committee (essentially the Specialist Advisory Committee for this specialty) began the current revision at the end of 2011.
We have been joined by three trainee representatives, young service users and a representative of Young Minds. They
focussed on aspects of the curriculum that would particularly affect service users’ experience of service and that of their
families, such as professionalism; they contributed to all aspects of this revision for which we are grateful.
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